An Evaluation of Erik
by BleedingHeartConservative
Summary: A series of drabbles in which the original Erik is objectively evaluated by a modern therapist. Each post a drabble EXACTLY 100 words, so the time commitment to read is not huge. Just for fun. Come and comment.  Parody, Angst, Psychological
1. Referral

**Author's note:** This has been a long time coming. It was first discussed as I wrote my novel-length sequel piece Therapeutic but was postponed because it doesn't really lend itself to regular chapter-length updates. I've been thinking about it again recently because a debate came up in a thread at phantomoftheoperaDOTCOM as to whether Erik suffered from bipolar disorder or not. I attempted to enter the conversation from an objective point of view and assign an appropriate diagnosis, but as I performed the differential, I determined that Erik possesses traits of almost every disorder known to modern psychiatry. And then some. Seriously. Those of you who know me know that I am trained as a therapist and have access to the Diagnostic and Statistical Manual (4th edition, text revision) which is used by psychiatrists, psychologists and counselors for purposes of differential diagnosis of psychological disorders. You may also know that the diagnosis of disorders and mental illnesses is very subjective. The same patient might visit three or four different doctors and come away with a different diagnosis from each one, and a complicated patient, as our dear Erik would surely be, is very likely to visit more than one mental health professional. Thus, this silly little bit of nonsense is not that outrageous in that regard. Of course, in order to have Erik meet with a clinician with modern training I had to choose whether he would be a modern-day Erik or not and decided that I wanted to stick with the original Leroux Erik as I usually do because he's my favorite and he's the one I know best. I also decided not to further complicate Erik's life by having him suffer the effects of time travel and the shock to his system by entering our modern-day world. Thus, our Belle Epoch Erik enters my office and is not at all disturbed by my modern attire, the telephone on my desk, the computer, or anything else. After all, the poor fellow has enough stress in his life without we add to it all of that. But feel free to comment on what would happen if we DID throw all that at him, because what the heck, it might be fun, too.

**Disclaimer:** My references for this piece are The Essential Phantom of the Opera by Gaston Leroux, edited by Leonard Wolf and the DSM IV TR. I know there are many other translations of Leroux's work and many other adaptations. I know, also, that the fifth edition of the diagnositic manual will be released soon, but as it is not yet available and the fourth edition is used daily in practice by clinicians across the country, that is what I will be using. I may occasionally refer to a copy of Leroux's work published in French, but as I am not fluent in French, this may or may not be helpful.

**One last warning:** I already mentioned that these will not be full chapter length posts. As a matter of fact, I will endeavor to make each one drabble length if at all possible. For anyone who does not know, a "drabble" is a piece of exactly 100 words. I assure you, while this will not look like much, it will be a great challenge to me to keep to clinical language and also to hit an exact word count. Wish me luck! Here goes with post #1!

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Clinician's Notes:

*Received referral for "Erik." Am told client presents with depressed mood and occasional bouts of extreme anger. Client referred due to "depression." Client is rumored to flaunt disregard for societal laws, but this is not confirmed. Client is said to have lived as a recluse for approximately ten years. Will begin with assessment for Major Depressive Episode/Major Depressive Disorder. Referring physician notes presence of unusual facial deformity. While it would be premature to suggest a diagnosis before a first appointment, given the physician's remarks, it may also be helpful to rule-out body dysmorphic disorder early in treatment. Initial appointment scheduled.*

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Whoo hoo! From asterisk to askterisk, EXACTLY 100 words!

Please leave a comment if you have the time!


	2. Adjustment Disorder

Author's Note: HA HA HA! Since drabbles are so short, it's easy to update often. Here are the clinical notes from Erik's first appointment. Poor Erik!

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*

Met Erik this afternoon. Client arrived on time and dressed more formally than expected for a clinical appointment. Specifically, client arrived in formal evening attire. Client is tall, unusually thin, and wears a false nose. Appears slightly older than his stated age with sparse dark hair. Client brought to appointment completed paperwork in red ink. Very unusual handwriting. Client was soft-spoken and subdued. Presented with dysthymic mood. Expressed intense sorrow over the recent abrupt end of a romantic relationship with a much younger woman. Cried. Reported that love interest married another. Preliminary diagnosis: 309.0: Acute Adjustment Disorder With Depressed Mood.

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100 words exactly! I will admit that clinical reporting allows for leaving out words like a, an, the, etc. which makes it WAY easier to hit an exact number. Even so, I'm still proud it's EXACTLY a drabble. Hope you're enjoying so far. Please leave a comment.


	3. Dysthymic Disoder

**Note to Silver Diva****:** Ha ha! Good question! My thought is that some concerned friend like the Persian gently persuaded him. Either that or he just felt desperate enough as he sat around waiting to die of love. Court-ordered clients are usually much more surly at a first appointment, and they _never_ fill out all their paperwork and bring it like they're supposed to. Thanks so much for reviewing!

**Note to Lisar****:** Certainly everyone is entitled to an opinion, and yes, I accept and enjoy every single review, regardless of whether it says positive or negative things. I'd like to respond further, but as you didn't log in, I can't reply directly. If you'd like an explanation, please feel free to log in and leave a comment. Regardless, thanks for your review.

**Author's Note****:** The clinical notes posted between the two *'s are exactly a drabble. The note below is provided just in case anyone is curious what the disorder looks like in non-literary characters.

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Clinical Notes:

*Asked Erik to share more about recently-ended relationship w/ 'Christine,' whom he tends to over-idealize. Client claims life devoid of happiness prior to meeting Christine. Client states that since end of relationship he is 'dying of love.' Denies suicidal ideation stating that if he had been so inclined he would have done so many years prior. Explored previous statement; client described self as "unhappy" even during childhood. Evident client has not experienced happiness in some time. Client described mother as also "unhappy." Session time ended before parent/child relationship could be sufficiently explored. Updated diagnosis: 300.4 Dysthymic Disorder (with early onset).*

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And for those who are curious:

**Criteria for dysthmic disorder:**

A. Depressed mood for most of the day, for more days than not, as indicated either by subjective account or observation by others, for at least two years.

B. Presence, while depressed, of two or more of the following

1) poor appetite

2) insomnia of hypersomnia

3) low energy or fatigue

4) low self-esteem

5) poor concentration or difficulty making choices

6) feelings of hopelessness

C. During the period of two years or more, the person has never been without symptoms for more than two months at a time

D. Criteria for major depressive episode are not met.


	4. ParentChild Relational Problem

A/N: Okay, so it's been two weeks and all I can offer you is this next drabble in the series. For those following The Phantom of Harrison High, I will try to post a chapter within the next week, but it's not a promise because life is CRAZY right now!

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Explored client's prior comments about his childhood and his "poor unhappy mother." Client reports his mother required him to wear a mask when child to cover his facial deformity. States mother would never allow him to kiss her but would run away and throw him his mask. Client reportedly ran away from home at an early age because his "ugliness" was "a source of horror" to his parents. Referred to his parents collectively yet stated father "never saw him," (due to the mask?). Client's relationship with father unclear. V61.20: Parent Child Relational Problem, R/O 995.52: neglect of a child, victim.

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Story note: It certainly doesn't take a psychotherapist to point out that Erik and his Mom had relational problems, so I figured I'd point out the obvious here. For those of you wondering, R/O stands for "rule out" and doesn't mean that it's BEEN ruled out, it means that the issue has been raised and that the clinician is going to try to rule it out over the course of the next few sessions. The numbers are codes that refer to different diagnoses. Relational Problems are "v" codes (which generally means they're pretty common usual things that most folks have some of, and typically your insurance doesn't pay for them. No worries, though. At $20,000 francs a month, Erik's got plenty of money to pay for his sessions, so rest assured he'll be in treatment a long time.

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Hey, you already know I'm all about the comments, right? So please do leave one!


	5. Major Depressive Disorder

I apologize that all I'm posting tonight is another drabble. Sadly, Harrison High will probably have to wait another week as I'm really REALLY busy right now. Sorry for that. But here's this. I hope you enjoy it.

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#

Discussed mood with client. Client's condition clearly meets criteria for diagnosis of dysthymia as pattern of depressed mood has lasted far longer than the requisite two years. However, mood appears to have worsened markedly during the weeks just before the end of recent relationship. Client admitted to having suicidal thoughts when object of affection declined marriage proposal. Stated "had enough of this life." Felt guilty and "deserving of death," experienced feelings of worthlessness (was "a poor dog ready to die for her"). Experienced exhaustion and inability to make clear decisions. 296.23 Major Depressive Disorder, single episode, severe, without psychotic features.

#

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For those wondering how the clinician reached this decision, the criteria are posted below. Also, I know we all suspect that if Erik has MDD, it would probably be "multiple episodes" but of course, their time is limited, so the clinician can only record what has actually been reported.

Criteria for MDD

1)

a. depressed mood

OR

b. loss of interest or pleasure in activities

AND

2) four of the following five

a. change in appetite, weight, or sleep

b. decreased energy

c. feelings of worthlessness or guilt

d. difficulty thinking, concentrating or making decisions

e. recurrent thoughts of death/suicidal ideation, plans, attempts

To qualify for diagnosis, must be accompanid by clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Comments not only welcome but eagerly sought out!


	6. Borderline Personality Disorder

Erik revealed events leading to end of relationship. Admits having deceived Christine early in relationship. First "date" was surprise encounter following performance. Does not consider it abduction, but admits he did abduct her some three to four months into the relationship when he learned she considering moving away. Admits to having used threats, manipulation, and guilt to prevent her leaving. States she attempted suicide to avoid marriage to him; he responded by tying her and giving her a time limit to change her mind. Now openly admits suicidal ideation: would kill self if she said no. Borderline Personality Disorder, 301.83

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Criteria for BPD:

1. frantic efforts to avoid real or imagined abandonment

2. pattern of unstable and intense relationships

3. identity disturbance, unstable self-image; sudden dramatic shifts in goads, values, vocational aspirations or sudden changes in opinions, plans, etc.

4. display impulsivity in at least two areas that are potentially self damaging (examples: gamble, spend irresponsibily, binge eat, abuse substances, engage in unsafe sex, drive recklessly, etc.)

5. display suicidal behaviors, gestures or threats (or self mutilating behaviors)

Note: I think that most therapists would be very hesitant to reach such a conclusion so early in treatment, especially considering the seriousness of a personality disorder diagnosis and the stigma it gives a client, but in the interest of moving things along (and making my point that Erik fits almost every diagnosis out there) I decided our clinician had to leap to a few conclusions. Otherwise, we could be here forever listening to Erik babble and never putting a label on it. Not only that, but yeah, most therapists are a little more conservative with such a diagnosis, but most therapists don't treat guys who abduct women and hold them prisoner and such. Not that all the details have come out, either. Erik's very careful with his words.


	7. Medical Referral

Apologies. Once again, a drabble is all I can post at the moment. I will admit, though, that as drabbles go, this is my favorite so far.

Continued to explore feelings associated with night relationship ended. After long silence, client revealed that he had experienced what he believed were hallucinations that night. Specifically, he recounted possible visual hallucination of seeing Christine's other love interest and auditory hallucination that the door bell was ringing after the individual had gone. As other love interest ("Raoul") was in the area that evening, visual hallucination seems unlikely. As the doorbell incident occurred shortly following swimming in a lake, I referred Erik to an otolaryngologist to rule out a possible medical explanation for ringing in the ears. Diagnosis deferred to medical doctor.

Comments?


	8. MDD, Severe, with psychotic features

Quick note: Still busy as hell. Will try to write some on other story this weekend, but prognosis not good. Meantime, please enjoy.

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Otolaryngologist reports no abnormalities in structure or function of auditory organs. Notes: "No medical history available but patient reports no prior experience of symptoms of tinnitus. Examination revealed no signs of recent infection. Patient reports no allergies. Performed irrigation of ear canal with no unusual effects. Unlikely that patient's brief swim on the night described would cause sensation of the ringing of an electric bell. Patient has been provided earplugs and encouraged to wear them when swimming solely as a precaution. Recommend follow-up with PCP and continue psychological counseling." Updated diagnosis: 296.24 Major Depressive Disorder Severe With Psychotic Features

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Does anyone need or want the criteria for a MDD with PF?

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Please comment if you enjoyed. Thanks! :-)


	9. bipolar I, severe, w psychotic features

Author's Note: Wow... it has been SO LONG since I've posted to this. It's been SEVEN MONTHS! You'd think somewhere in that space of time I could put together 100 words, eh? I'm really sorry! Anyway... here's the latest in Erik's interaction with this therapist. Big surprise... Erik has bipolar!

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In attempting to solidify Major Depressive Disorder diagnosis, performed differential diagnosis and discussed with client differences between depression and bi-polar. Client reports experiencing manic-like symptoms such as staying up all night to complete masterpiece, little need for food or sleep, initiating large number of mischievous pranks. Despite aforementioned low self-esteem, client demonstrates grandiose self-image (is greatest ventriloquist in world, his composition exceeds work of Mozart). Description of self during relationship meets criteria for manic episode. "Rosy hours" period from past may also meet criteria for mania. Diagnosis, 296.54, bi-polar I severe with psychotic features, depressed type with recent depressed episode.

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I think I'm finally caught up at work, so there will be most posts for both this and _The Phantom of Harrison High_. Thanks to all who have reviewed in the past and thanks in advance to all those who will review this time. Please do so, if you have a moment. I appreciate it.


	10. Anorexia

Anticipated focus of session was Erik's feelings towards psychiatric referral for confirmation of bi-polar and evaluation for treatment. As previously noted, however, client is abnormally thin. Client has lost considerable weight since first session. Maintains he is 'dying of love,' not starving. Although concerned about body image, fixation is not upon weight, therefore criteria for anorexia nervosa not met. Nevertheless, client is medically anorexic (weighs 85% normal weight for height and age) perhaps due to depressive symptoms. Client denies connection between weight and emotion. Cites career as "living corpse" in freak show. Diagnosis: No change. (Anorexia Nervosa ruled out.)


	11. Body Dysmorphic Disorder

Author;s note: LOL. This is actually more fun than I think I should be allowed to have using a book that was designed for work...

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Explored further client's work history. Discussed performance in sideshows. Client reports he traveled city to city exhibiting self as "living dead man" throughout youth. Although he continued to be self-depreciating regarding appearance (described self as "built up of death from head to toe" and "a corpse"), he spoke with grandiosity about past as a performer. Client claims no negative emotional consequence of freak show employment. On the contrary, states negative self-concept was formed long prior and employment offered monetary gain and financial freedom. Client states skills acquired during employment led to a position of power. R/O 300.7 body dysmorphic disorder.

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A quick therpeutic note: R/O means "ruled out" and our therapist is determining that this is NOT a valid diagnosis for Erik because his deformity is not the direct cause of his emotional problems. That is to say he doesn't spend all day staring in a mirror fixated on something he wants to change about himself. Also, typically you're classified as having BDO if there is something small wrong with the way you look and you obsess and exaggerate it. Erik... well... would have plenty to complain about but at times has not let his appearance hold him back.

The usual plea: Please consider leaving a review. Thanks!


	12. Narcissistic Personality Disorder

Attempted to further explore client's past as a side-show performer. Erik explained that during that time he learned music, magic, ventriloquism and juggling. He reiterated his position that he is the best ventriloquist in the world. Also claimed that his magic tricks and juggling were so remarkable that caravans of gypsies talked about him all the way from Russia to Persia. Client claims to have been sought out by Shah of Persia to entertain Shah's wife. Claims became influential in court and was single-handedly responsible for winning Persian-Afghan war. Unable to verify truth of client's claims. 301.81 Narcissistic Personality Disorder

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For those wishing to independently verify Erik's diagnoses, here are the criteria for Narcissistic Personality Disorder.

Overestimate their abilities and inflate their accomplishments. Appear boastful and pretentious. Preoccupied with fantasies of unlimited success, power, brilliance, beauty or ideal love. Ruminate about "long overdue" admiration. Believe that they are superior, special or unique and expect others to recognize them as such. Generally require excessive admiration. Their self esteem is very fragile. Constantly fish for compliments and favorable treatment. Their sense of entitlement and lack of sensitively results in the exploitation of others. Often do not recognize the feelings of others. Are envious of others and/or believe that others are envious of them. Display snobbish, disdainful and patronizing attitudes


	13. Antisocial Personality Disorder

Returned to discussion of night of Christine's departure. Discussed hallucination that "Raoul" rang bell. Client stated Raoul could not have rung the bell, yet he was certain he saw him. Could not have been Raoul because after client drowned the apparition, Raoul was still present in torture chamber. Client reminded this clinician of counselor-client confidentiality. Noted terrible things happen to those who do not protect "Erik's Secrets." Once reassured confidentiality would not be breached for past, only to protect client and others from future harm, client admitted to incident involving a chandelier and a frog. 301.7: Antisocial personality disorder

**Please review.** And in case you'd like the criteria for APD:

A: pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years as indicated by three or more of the following:

1. failure to conform to social norms with respect to lawful behaviors as indiated by repeatedly performing acts that are grounds for arrest  
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure  
3. impulsivity or failure to plan ahead  
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults.  
5. reckless disregard for safety of self or others  
6. consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations  
7. lack of remorse as indicated by being indifferent to or rationalizing having hurt, mistreated or stolen from another.

B: the individual is at least 18 years of age

C: there is evidence of Conduct Disorder (a childhood diagnosis similar to this one)

D: The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode


End file.
